Form

Part 1 - Fill out personal information
Full Name

First Name Last Name
Social Security #
E-mail
Date oF Birth

- Month - Day Year
Gender

Male Female

Place Of Birth

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Ethnicity
If Other Please Specify

US Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Foreign Address (If Applicable)
Home Phone

- Area Code Phone Number
Work Phone

- Area Code Phone Number
Fax

- Area Code Phone Number
Occupation
Church Name
Denomination
Degrees Held
Credit Desired

Academic Credit from another institution (Official Transcript(s) must be mailed to ECUA) Life Experience Credit (Fill out information in Part III)
Exact Name To Appear On Diploma
Part 2 - Select Degree Program
Associates Degree

Associates of Arts in Bible (AA) 60 Credits in Bible transferrable to the Bachelor program
Bachelor Level (Choose Emphasis)

Theology Ministry Christian Education Christian Counseling
Graduate Level

Master's Degree In Theology (Th.M) Master's Degree In Ministry (M.Min) Master's Degree In Christian Education (M.C.E.) Master's Degree In Christian Counseling (M.C.C.)
Post Graduate Level

Doctor Of Theology Degree (Th.D.) Doctor Of Ministry Degree (D.Min.) Doctor Of Christian Counseling Degree (D.C.C.) Doctor Of Christian Education Degree (D.C.E.) Doctor Of Philosophy (PhD)
Non-Academic Programs by Thesis

Doctor of Religious Philosophy (D.R.P.) Doctor of Pastoral Studies (D.P.S.)
Degree(s) By Testing:

Bachelor Master Doctorate Combination Master/Doctorate
Tell Us How You Plan To User Your Degree
Part 3 - Life Experience Credit
Please provide information to be considered in awarding credit for life experiences. List all ministerial experience. Thank you.
Life Credit 1
Date & Length of Ministry
Ministry Name & Address
Your role & hrs/wk involved
Life Credit 2
Date & Length of Ministry
Ministry Name & Address
Your role & hrs/wk involved
Life Credit 3
Date & Length of Ministry
Ministry Name & Address
Ministry Name & Address
Your role & hrs/wk involved
Part Four—Doctrinal Views
Salvation
The Trinity
Water Baptism
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If you have not heard from us within 24 hrs., please contact us at: dean@ecua.edu.
Should be Empty:

Part 1 - Fill out personal information

Part 2 - Select Degree Program

Part 3 - Life Experience Credit

Part Four—Doctrinal Views